Radiologic Exhibit Wrong Road

History

Turns on of Progress1

Davidj

DiSantis,

MD

Radiology’s

Denise

M. DiSantis,

#{149}

BS

U INTRODUCTION Radiology has been blessed with remarkably insightful proponents since its inception. Consequently, the first century of radiologic one ofunparalleled advance. Not unexpectedly, given this rapid radiology has occasionally suffered a mild case of the intellectual cled herein are some of the missteps along the way.

and practice ascent, “bends.

practitioners has been American “ Chroni-

U AMERICA LEARNS OF X RAYS Even the introduction of the new science to Americans was a bit off-key. The New York Sun touted the mysterious “light that never was” onjanuary 6, 1896 (Fig 1), crediting its discovery to Professor Routgen [sicj “Roentgen ray fever” promptly became an American epidemic. With nearly 1,000 presentations and articles dealing with x rays appearing within the first year (2), it was obvious that both the medical community and lay public were thoroughly enamored of the new marvel. Extended (unshielded) fluoroscopy became de rigueur during physical examinations (Fig 2). .

Long

lines

hours

formed

(Fig

at public

3) to amuse

appeared,

derwear

ture The

and

so in

coated U ARE Reports

1896

But

he

THESE

in x rays

introduced

wider

paint

RAYS

was

(4)

(Fig

his

Edison

after

exposure

Index

terms:

1 From

the

7, 1991;

Department Recipient

accepted

C RSNA,

1991

See

the

also

1991;

article

Dally,

“Experimental

Radiations,

RadioGraphics

VA 23505.

Clarence

observed,

bill

(5). efforts

legisla-

ofThomas their

fluoroscopy

oflight

un-

the NewJersey

in

at increasing

type

for

x-ray-proof

Edison. public

unit

bulb-an

Edi-

availabil-

(4)

x-ray

(Fig

4).

tube

SAFE?

damage

assistant,

fluoroscopy

for ladies’

5).

to x rays

controversy regarding the injurious Nikola Tesla blamed ozone for the damage sort of electrical burn. Dogmatic wrong-headed muddy the issue (Fig 6). But danger lurked After

underwent

home

for his new

the

mas

aimed

a recreational

appeal

fluorescent

of skin

subjects

Advertisements

tongue-in-cheek) ofx rays into opera glasses can be traced in pan to the

interest

even

with

(4).

as did a (perhaps

entrepreneurial

He anticipated

where

customers

banning incorporation popularity ofx rays

son’s ity,

exhibitions

the

injurious

became

work #{149} Radiology

effects

and

began

to appear

as early

as 1896.

effect could not have been more heated. (3), while others thought it was some pronouncements did much to on both sides of the fluoroscopy screen. the

with

first

American

x-rays

will

radiologists,

x-ray

be but

casualty,

slightly

Tho-

affected

by

history

11:1121-1138 of Radiology,

ofa August

by Sirr

Certificate 22.

Address

(p 1068)

DePaul

Medical

ofMerit

for

reprint

in this

Center,

a scientific requests

Eastern exhibit

Virginia at the

1990

Medical RSNA

School, scientific

150

Kingsley

assembly.

Ln, Norfolk, Received

August

to D.J.D.

issue.

1121

THE LIGUTTHAT!KYIRJA. ,

--.$

A PbotoripbIe to

Tb.

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NEW YORK. Js. Sun froni London

not

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7..-A

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to tat

csblghm

Tb. nala. d#{149}trsct ttentlon

of

war’s

rm th.#{149} marv#{149}Ious triumph of science whlcb Is reported from Vi#{149}nna. It Is announced that Prof. Routgu of the Wurburg tnI..

alerma

should

versity has the purpo

discovered

a

light

which,

for

of pbotoraphy, Will penetrate wood, e.b and moat other organic subaLancee,. The Proaor baa succeeded In photographing m..l weights which were In

a

hand,

closed whlc,h

flbbing

wooden shows Inv!elble.

case; only

also the

a,

man’s

bones,

.

‘

the 2.

1. 1-3. rays,

(1) “Routgen’s” amazing announced by the St Louis Post Dispatch on January 7, 1896. (Reproduced, with permission, from reference 1.) (2) UnFigures

shielded patients, operators, and tubes were the rule for fluoroscop-

ic examinations they suspect

in 1896. Little did that the test was worse than the disease. (Reproduced, with permission, from reference 2.) (3) Exhibitions did indeed expose the public to ‘the new marvel.” (Reproduced, with permis‘

sion,

from

reference

3.)

3. Figure 4. Drawing ofthe Edison for recreational home fluoroscopy. permission, from reference 4.)

1122

U

RadioGrapbics

U

DiSantis

Vitascope,

intended

(Reproduced,

and

DiSantis

.

#{149}

with

Volume

11

Number

6

r

orrcponbcnce.

NO

PRACTICAL

DANGER

FROM February

BOSTON,

MR. EDITOR : In your issuo lislied a letter from Dr. William periment. which, if confirmed by

of

-

me of very

great

importance.

his

delisctions.

incapable

ganic

Other Of

life.

Rollins,

the the

even

however,

I do not

the

18,

1901.

14th

i

x-ray fact

his

pub. an

observers,

medical

of

X.RAY.

describing

future

experimenters

destroying

February

If the

destroying life in the maininalia, be brought to tile attention of Rollins does not give the details

TILE

ex-

eem

to

is capable

of

shoul(l

certainly

Dr.

profession.

experiment, have

crvptogavnic PrOP5e to

found

merely. the

x-ra

forms contradict

of Dr

R&.liins, and leave to tile piiysicist aud Figure 6. Venerable radiology pioneer E. A. Codman reassures readers of the New EnglandJournal ofMedicine (then known as the Boston Medical and Surgicaijournal) that fears of x rays are ovenblown. (Reproduced, with permission, from reference 7.)

L

my

discovery

of their

harmful

effects.

I have

a

[lead] screen one-half inch thick in my laboratory, and would continue the experiments, but my wife won’t let me” (8). With the consensus regarding the potential danger slow to grow and bolstered by early successes in tumor treatment, x rays were applied to an amazingly wide range of maladies, from ringworm to frostbite. Training for physicians who used x-ray

equipment

was

stressing

posures tinued physicians

were

in no

patients.

A 1948

study

(Fig

revealed

light

from

reference

November

1991

bulb.

(Reproduced,

with

(Fig

7), rarely

gross

overex-

jeopardy

of the

radiation

than

hands

damage

their

of radiolo-

in 48%

(10)

9).

THE

its use

rays.

Beginning

used

in beauty

ofx were

unwanted facial largest operation,

tube

less

U X RAYS IN American business units

mission,

at best

Consequently,

by inexperienced practitioners conwell into this century (Fig 8). X-ray

gists

his x-ray

cursory

safety.

was

MARKETPLACE

even

and body known

more in the parlors

liberal 1920s,

in x-ray

to remove

hair (Fig 10). The as the Tricho Sys-

per-

6.)

DiSantis

and

DiSantis

U

RadioGraphics

U

1123

eth

iitk

Iot::

tabuatt

MEDICAL

SCHOOL

FALL

Special

For

ill

matriculates

with

Roentgen

Figure

8.

Photograph

shows

lower

back

by an x-ray fluoroscopic

burn from a single gastrointestinal examination. The fluoroscopist

three

patients

with

more

permission,

scientific

apply

THE

East

time

be combined,

at

their and

disposal completed

Technique. and

Plate

detailed

particulars

concerning

special

to

SECRETARY 20th

Reading.

Therapy.

further

courses,

303

coiupletc

of six weeks:

Fluoroscopy

7. Cram course on sham course? One could become a radiologist, radiographen, and radiation therapist in just 6 weeks. (Advertisement from AJR 1917; 4:XVIII.)

limited

may

Roentgenological

.

Figure

1917

for thorough,

courses

period

For

HOSPITAL

in Rocntgcnology.

following a

SESSION,

opportunities

‘instruction

the

AND

OF

Street

THE

FACULTY New

York

City

scar caused tract burned

that same day (9). (Reproduced, from reference 9.)

4

,

1124

U

RadioGraphics

U

DiSantis

and

DiSantis

I

Volume

11

Number

6

Figure

9.

Photograph shows multiple, cell carcinomas on the hand

squamous radiologist.

(Reproduced,

with

ulcerating

of an early

permission,

from

10. What price According to the Victor X-Ray ConpoFigure

:

.

x. R*v

C AC0 H

APPAAATUS.

IC

Tu ur

CooLsosE

a

a

RIS(ARCH

0

CHICAGO

April

25th.

)

1922.

Kernpemith

!lilwaukee.

}tfg.

just

Co.,

Wiso.

$385.

(Re.

produced,

with

sion, from Collection,

the Hammer Archives

Center,

:

The

beauty? ration,

scc,.ccy*o,

A*a*vus

PHYSIOTHSNAPY

7

permis-

National

Mu-

scum

ofAmenican

His-

tory,

Smithsonian

Insti-

tution.)

.

Gentlemen: ?rotn your letter of April 21st, we aseume that you are interested in email portable high frequenoy outfits for uae in beauty parlors. The emaileat type of outfit whiob we mano.faoture for high frequenoy and treatment work is deecribd in the bulletin enoloeed. The price ic $385.00, and is arranged for alternating current. Thie outfit of oourae is designed primarily for use by the physicians, and would posaibly be too high in pri3e to permit of its use by your ouatozner. However, please

do

not

hesitate

if

we in

nan

be

of

calling

any on

aervioe

you,

us.

Yours

vIctoR

to

very I-RAY

truly. COIIPORATION.

#{182}= j/LNP

November

1991

DiSantis

and

DiSantis

U

RadioGraphics

U

1125

r’’

Figure 11 Photograph of a woman who went x-ray epilation treatments at a beauty

under-

.

shows skin scanning and atrophy. with permission, from reference

shop

(Reproduced, 13.)

Figure tem, was extremely successful and had multiple franchises in the United States and Canada. A 2-week course was taught to the beauticians,

who

then

irradiated

patrons

with

estimated 500 rad (5 Gy) for epilation The number of women who suffered dermatitis,

burns,

is believed

to have

(Fig

ulceration,

been

and

in the

an

(1 1). radioskin

12.

Photograph

Many

remember

12).

10,000 Sales

In the

units people

radiation

and salesperson watched controlled

could

check

the

as the child

fit

his or her toes wiggle. X-ray output was with a three-stop dial labeled ‘ ‘Men,

Women, Children.” (Courtesy of Nancy PhD, American College of Radiology.)

Knight,

cancer

thousands

(12)

the late

were

in use

untrained

safety

shoe

1950s,

store

fluoroscope

approximately

in the in even

performed

United

States.

rudimentary

countless

fluoro-

scopic

shoe

delivering second frequently

high

fittings,

of scattered

pelvis,

employees ness ing

that

scopic

peryear

RadioGraphics

U

DiSantis

and

DiSantis

often

on

radiation

as well (Fig

grew

appeared

most

children,

doses up to 5.8 rad (0.058 Gy) per (1 1). Because shielding on these units was inadequate or faulty, relatively

doses

child’s

U

foot apertures The top of the unit so that the parent

11).

(Fig

1126

shows

of a shoe store fluoroscope. sported three viewing ports

13).

in the

on shoe customers fittings

as adjacent As radiation

late

1950s,

store be

per

day

reached

the

patrons

and

safety

warning

fluoroscopes, limited and

to three not

more

awaresigns

suggestfluorothan

12

(11)!

Volume

11

Number

6

Figure 13. graph shows

Photosevere raof the feet

diodermatitis

of a shoe store employee whose fitting fluoroscope had faulty shielding.

(Reproduced, from

with permission, reference 14.)

14. The explosive popularity of radium made it a “hot’ commodity in more than one sense. (From the New YorkAmerican, May 8, 1904. Reproduced, with permission, from the Hammer Collection, Archives Center, Figure

BURGLAR J[fl’:H

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National tution.)

;.

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History,

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Insti-

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ENTER and

RADIUM Pierre Curie’s

Marie

in 1898

mania.

touched ‘‘

element less) tion

offa

discovery new

round

of radium of “ray

The mystery and romance of a new (one discovered by a woman, no

that produced without the

constant abundant radiacumbersome apparatus needed to generate x rays electrified the scientific community and lay public as well. The mystique was enhanced when it was revealed that radium actually changed into other dcments-alchemy

come

true.

Despite

the

To say that radium was viewed early on as a godsend panacea is to understate the prevalent perceptions (Fig 16). Spectacular accounts of radium-induced tumor shrinkage prompted physicians to try it for maladies ranging from hypertension to schizophrenia. There seemed to be no reason for caution, as the journal Radium declared in 1916, “Radium has absolutely no toxic effects, it being accepted as harmoniously by the human system as is sunlight by the plant” (Radium 1916; 7:24). According to some, radium might even be the source oflife itself (Fig 17)! since,

scar-

city of radium and the resultant spectacular cost (Fig 14), public fascination prompted the incorporation of radium into everything, from chocolate to contraceptive jelly (5) to cleansers (Fig 15).

November

1991

DiSantis

and

DiSantis

U

I idioGrapbics

U

1127

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were nwy &;..t offer, because bay.

puopic of

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the

It)

obtain

nearly

a RadIum

every

State

Eclipse in

the

Sprayer

t’nion.

on

a re,,

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(f

Hammer

DiSantis

Radium Cleanse timed.

modern

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special

another

act dema lot of

Radium Eclipse Sprayers Absolutely Free

neer

with

in

overwhelming

otTer

250

s.’-

dapptnnt.ed

the

Collection,

radium insecticide and furniture polish. Virof the radium entrepreneurs. (Reproduced, Archives

Center,

National

Museum

of

Institution.)

Volume

11

Number

6

FOR GAS,ELECTRICITY AND AS A POSIT!VErr EVERYDISEASI

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1991

Themostamazing

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quite true.

June

YorkJournal,

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the (From

oppothe

21, 1905.

permission,

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1129

THERAPY

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easy

(a) Treatment with a home

(Reproduced,

with

15.) (b) Radithor

with liquid sunshine radium water dispermission,

from

was a 1920s

ref.

radium

tonic and contained more than 2 p.Ci (74 kBq) of radium per bottle. (c) This guarantee assured Radithor customers that they were getting the real thing. Ironically, it was the manufacturers whose tonics contained too little radium that ran afoul of the law. (Figs 18b and 18c reprinted,

with

permission,

from

reference

b.

1130

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DiSantis

and

DiSantis

Volume

11

Number

6

b.

C.

Figure the

19. (a, b) “Let New York Technology

Hammer

Collection,

A favorite

us ‘rays’ Club.

Archives

means

our glasses.” Toasting with liquid (c) Recipe for the radium cocktail.

Center,

ofgaining

the

National

Museum

ofAmenican

away

much-

touted health benefits was to ingest radiumimpregnated water, known bucolically as “liquid sunshine. ‘ ‘ Hailed not only as salubrious tonics (Fig 18), radium beverages were an

dinner

instant

loved

hit

quet circuit on radioactive

November

1991

as fluorescent

(Fig

19). china

cocktails

Dinner could (Fig 20), then

on

the

ban-

sunshine cocktails at the 1904 (Reproduced, with permission,

ing

History,

Smithsonian

radium

toothpaste

with

entertainment game

haps

just

luminous

evening crucifix

radium

(Fig

(Fig

(Fig

(Fig

before 23).

2 1). After-

include

roulette

prayers

of the

Institution.)

might

of radium

banquet from

a glow22)

or

per-

an ever

American

business

24).

be served cleansed

DiSantis

and

DiSantis

U

RadioGraphics

U

1131

Figures

20-22.

(20)

“Hot”

plate.

Scintigram

Fiestaware dessert dish. These uranium-glazed were produced from 1935 to 1971. Acidic

of a

dishes foods can

leach traces of uranium out of the glaze (5). (Courtesy ofClaude Hesselman, DePaul Medical Center, Norfolk, Va.) (21) A perky German advertisement (ca 1935) for radioactive toothpaste. The rays were said to provide a “healthful massaging of the gums.” (Courtesy of Ben Participan’ts

(22) they

imagined.

coated

with

Z. Swanson, Jr, MD, gambled with higher

The wheel,

balls,

luminescent

radium

Baltimore.) stakes than

and chips paint.

were

(Article

ap-

peared in 1904; reproduced, with permission, from the Hammer Collection, Archives Center, National Museum tion.)

ofAmerican

History,

Smithsonian

Institu-

20.

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11

Number

6

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for a crucifix with Archives Center,

a decidedly unheavenly glow. National Museum ofAmerican

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(Reproduced, with permission, History, Smithsonian Institu-

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DiSantis

and

DiSantis

U

RadioGrapbics

U

1133

DADTC Was radium a panacea or Pandora’s box? Its discoverers found they could not escape it (Fig 25), and its proponents and partakers came to rue its advent (Fig 26). In the 1920s, the popularity of radium was unabated, with glowing radium paint particularly ubiquitous in products from fish bait to doll eyes. As Dr Sabin von Sochocky, developer of ‘ ‘Undark” radium-based paint observed in 1921, “The time

will

doubtless

come

when

you

will

so

.

D1UMINFECTS T..ffE CURRIES LILEAPESTI

have

.

thoroughly

that

even

the

ing

with

workers’

radioactive

arnis

Discoverers of Wonderful Element So Permeated: with Its Rays That They Livej

paint

undergarments

glowed

.

(5). Safety women

spattered was

such

painters

radium

paint

a nonissue

sometimes to their

that

the

applied fingernails

the

glow-

and

teeth

1 Constant State of Radiation

for special occasions point on the brush,

(5). To get the finest the painters passed their between their lips and thus swalminute amounts of radium-based paint

brushes

lowed (Fig

28).

So permeated

with

IAUNTED BY A SORT OF MINERAL FRANKENSTEIN

radioactivity

were the dial painters that they could light a fluoroscopy screen with their breath, and yet an autopsy revealed that the lethal dose had been less than 70 cents worth of radium. Amazingly, because of the long latency be-

25.

TheRadium Water Worked Fine Until His JawCarne Off

and disease, the U.S. Radium evaded culpability by invoking the statute oflimitations (5). The deaths of the dial painters plus the bungeoning casualty list of early x-ray workers tolled the close ofAmerica’s uninhibited love affair with radiation. But by then, some “rayvangelists” had already given in to temptatween

Company

tion.

OFT.

I-rnt1:)

in your own house a room lighted entirely by radium like soft moonlight” (5). The rapid fall of radium from grace began with the deaths of several young women, painters ofluminous watch dials (Fig 27). Their mysterious osteonecrosis and profound anemia prompted a search of their workplace, the U.S. Radium Company. The unshielded work area and the painters themselves were .

RADIUM!

exposure nearly

Heady

with

newfound

power

thanks

Cancer Researcher Unearths A Bizarre Tale of Medicine And Roaring ‘20s Society

to

26. Figures

more

25, 26. (25) than misspelling.

The Curies were to suffer Marie Curie died of radiaanemia. (From the New York

tion-induced aplastic Journal, April 30, 1905.

Reproduced,

sion, from the Hammer Collection, ter, National Museum ofAmerican

sonian

Institution.)

(26)

The

debt

with

begins

due, as seen in the headline from a story the demise of a radium tonic user. (From StreetJournal, August 1, 1990.)

1134

U

RadioGraphics

U

DiSantis

and

DiSantis

permis-

Archives History,

Volume

CenSmithto come

detailing the Wall

11

Number

6

27.

Figures 27, 28. and the complete graph

obtained

permission,

November

1991

(27)

Photograph

absence by placing

from

reference

shows

the

work

area

of the

radium

ofshielding. (Reproduced, with permission, the teeth of a radium poisoning victim atop 18.)

DiSantis

dial

painters.

Note

the

street

clothes

from reference 17.) (28) Autonadiophotographic film. (Reproduced, with

and

DiSantis

U

RadioGrapbics

U

1135

Figure

29.

The self-righteous

with permission, from Smithsonian Institution.)

1136

U

RadioGraphics

the

U

employ Hammer

DiSantis

the new science

Collection,

and

DiSantis

Archives

in attempts Center,

to foist dubious National

Museum

blessings. ofAmerican

Volume

(Reproduced, History,

11

Number

6

Figure 31. 1990 cereal

As this photograph of a box attests, radiation fully assimilated into cur-

remains

rent

culture.

hands

of this

A careful famous

look

at the

threesome,

however, reminds us of the hazards of ‘ ‘x-ray’ viewer overuse. (Courtesy ofKellogg Corporation.) ‘

RRDIUM! .“,

Bleaching the Negro to Be Tried with Itat California University1 X-RAY

WILL

BEUSED,

SAN

FRANCISCO. with the experiments

be uwd ling

fornla.

Au

I theTheskintestsof .

ert

A.

I will

attempt

flees.

I Chemistry, qors. The . radium ill 1‘t tbe wo be

Jan.

X-ray at the

will

21.-RadIum In a series University

be

.

under

the

vi11 be ‘xperlments,

the on the

coloring

will of startof C&ll-

made

a negro white. have been undertaken a senior In the

X-ray

TOO.

dirtion combined

to

turn

by RobCollege of of

prbfesthe effects

radiation, they sought to reshape society more to their liking (Figs 29, 30). Even William Rollins, the patron saint of early radiation safety, succumbed briefly to the dark side of the force, as evidenced by his article titled “On the importance of treating the generative organs of degenerates by X light to prevent their increase” (19). Happily, the period was briefwhen radiology journals’ pages were sullied with titles such as “Sterilization in the interests of race betterment’ ‘ (20). U CONCLUSION Only the benefit of the “retrospectoscope” permits a smug review such as this one. The giants who piloted radiology through the groping, formative years stand no less tall for these brief detours from the true path. And though the applause for the blessings of radiation has been tempered by recognition of its perils,

the

sheer

undiminished

fascination (Fig

with

it remains

thanks

to Nancy

31).

with

and tb cells of the

body

determined.

Acknowledgments: Knight, PhD, American Thomas

Xenakis,

Special

College

of Radiology,

MA, Art in Medicine,

Norfolk,

and Va.

Figure 30 More experiments in human beii ment.” (Article appeared in 1904; reproduced, with permission, from the Hammer Collection, Archives Center, National Museum ofAmerican History, Smithsonian

November

1991

Institution.)

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and

DiSantis

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1137

U 1. 2. 3.

4.

5.

6.

7.

8.

9.

10.

1 138

U

REFERENCES DiSantis DJ.

11. Early

American

radiology:

the

pioneeryears. AiR 1986; 147:850-853. Grigg ERN. The trail of the invisible light. Springfield, Ill: Thomas, 1965.. Bruwer AJ. Classic descriptions in diagnostic roentgenology. Vol 1. Springfield, Ill: Thomas, 1964. Brecher R, Brecher E. The rays: a history of radiology in the United States and Canada. Baltimore: Williams & Wilkins, 1969. Caulfield C. Multiple exposures: a chronicle of the radiation age. New York: Harper & Row, 1989. Brown P. American martyrs to science through the roentgen rays. Springfield, Ill: Thomas, 1936. Codman EA. No practical danger from the x-ray (letter). Boston Med SurgJ 1901; 144: 197. Mr Edison and the x rays (abstr). Arch Roent-

gen Ray 1903; Garland LH.

8:45 X-ray burns

resulting

from

roscopy of the gastrointestinal tract. JAMA 1945; 129:419-421. Braasch NK, Nickson MJ. A study of the hands of radiologists. Radiology 1948; 51: 719-726.

RadioGrapbies

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and

DiSantis

fluo-

12.

13. 14.

15.

Schubert J, Lapp RE. Radiation: what it is and how it affects you. New York: Viking, 1957. Cipollaro AC, Einhorn MB. The use of x-rays the treatment of hypertrichosis is dangerous.JAMA 1947; 135:349-353. Hazen HH. Injuries resulting from irradiation in beauty shops. AJR 1930; 23:409-412. Kopp H. Radiation damage caused by a shoe-fitting fluoroscope. Br Med J 1957; 2:1344-1345. Mould R. A history ofx-rays and radium, with a chapter on radiation units: 1895-1937. London: IPC Building and Contract Journals,

for

1980. 16. 17.

Macklis radium Kathren

ment: New 18.

19.

sources, York:

distribution,

Harwood

and

Academic,

C.

surveillance. 1984.

Gettler

A, Norris

radium

water. JAMA 1933; 100:400-402. W. Note on x light: on the impor-

Poisoning

Rollins tance of treating the generative generates by x light to prevent (abstr).

20.

RM. Radithor and the era of mild therapy. JAMA 1990; 264:614-618. RL. Radioactivity in the environ-

Hegar

Arch

Roentgen

Wiesloch A. betterment

estofrace

Ray

1905;

from

drinking

organs of detheir increase 9:296.

Sterilization in the inter(abstr). AJR 1916; 3:46.

Volume

11

Number

6